Traumatic Brain Injury in the United States:
A Report to Congress
CDC's Traumatic Brain Injury Surveillance Program, 1989-1998
Ongoing, population-based surveillance systems--and registries to define disability and other outcomes associated with TBI--are essential for planning and evaluating prevention, acute care, and rehabilitation services for people with these injuries. Yet such systems have only recently been established. Before 1990, most TBI data came from either hospital-based clinical case series or epidemiologic studies that were of limited duration and restricted to particular locales. Despite the limitations of these data sources, they revealed some useful insights into the epidemiology of TBI.
During the 1970s and early 1980s, researchers estimated that each year, about 500,000 Americans sustained a brain injury leading to hospitalization or death.6 The reported annual incidence of TBI in different localities ranged from 132 to 367 injuries per 100,000 population,7-15 with the best estimate of national incidence at about 200 per 100,000 population.16 Different case definitions for TBI and varied methods of collecting data made it difficult to compare information from these studies, combine data across studies, and thus estimate the national incidence of TBI.17 In the case definition, for example, not all studies included skull fractures without other neurologic symptoms, and some excluded immediate deaths that did not involve hospitalization. Most studies focused on limited geographic areas that were not necessarily representative of the United States as a whole. From these studies it was not possible to evaluate U.S. trends in the occurrence of TBI-related hospitalizations.
CDC began promoting the development of a multistate traumatic brain injury surveillance system in 1989 with funding support and technical assistance, after the Federal Interagency Head Injury Task Force Report identified the need for better information on the public health impact of brain injuries.18 The surveillance system's function is to characterize the risk factors, incidence, external causes, severity, and outcomes of traumatic brain injury in the population. Such improved data collection can help achieve two important public health goals:
Primary prevention. Effective programs should be targeted to address specific causes of TBI and populations at higher risk.
Acute care and rehabilitation. Accurate data are needed to improved injured persons' access to health care and other necessary services.
In 1995, CDC published Guidelines for Surveillance of Central Nervous System Injury19 to help ensure that the multistate TBI surveillance system would generate valid and timely information representative of the U.S. population. These guidelines provide a standard case definition (Appendix I) of traumatic brain injury (craniocerebral trauma) that can be summarized as an occurrence of injury to the head (arising from blunt or penetrating trauma or from acceleration-deceleration forces) that is associated with symptoms or signs attributable to the injury-- decreased level of consciousness, amnesia, other neurologic or neuropsychologic abnormalities, skull fracture, diagnosed intracranial lesions--or death. The Guidelines also clearly define the data elements necessary to describe the occurrence and severity of these injuries, their external causes, and associated risk factors. The core of these data elements can be obtained from hospital discharge reports, which are readily available to most State health departments.
The most recent developments in CDC's TBI surveillance program include the following:
In 1995, CDC funded an extensive follow-up study to describe TBI-related disability in Colorado and to develop methods for ongoing studies of longer-term outcomes of TBI in State populations.
In 1997, CDC published initial findings from the multistate TBI surveillance system, including data from four States: Colorado, Missouri, Oklahoma, and Utah. Two of these States (Colorado and Utah) recently published their separate findings.
In September 1997, with the help of funding provided under Public Law 104-166, CDC added 11 States to the system, bringing the total number of participants to 15. Participating States now include Alaska, Arizona, Arkansas, California, Colorado, Louisiana, Maryland, Minnesota, Missouri, Nebraska, New York, Oklahoma, Rhode Island, South Carolina, and Utah. Together, these States are quite representative of the diversity of populations found throughout the United States.
Executive Summary
Introduction
CDC's Traumatic Brain Injury Surveillance Program, 1989-1998
Current Data on Traumatic Brain Injury Mortality and Morbidity
CDC Estimates of Traumatic Brain Injury-Related Disability
Public Health Goals
References
Appendix: Methods Used to Produce Estimates for This Report
